Patient Education & Resources

Introduction to Vascular Disease

NOTICE: This website is meant to function as a general information site. The information and advice given here is for the purpose of background information. If you have a specific question or concern, we advise you to contact your Family Physician who is best equipped to evaluate your exact situation.

What is Vascular Disease?

Vascular disease is a condition in which the arteries start to become abnormal in their structure, function, or both. The earliest stages of vascular disease are visible only under the microscope. Unfortunately, for most of us, the changes begin in early life, as early as the teen years and steadily worsen thereafter.

What goes wrong with the blood vessels?

The blood vessels we are talking about here are the arteries. They are the structures that carry blood from the heart to all the organs and tissues of the body including brain, kidneys, gut, muscles, and the heart itself. Below are a series of illustrations that will help you understand the process of atherosclerosis (vascular disease) and the kinds of problems that can arise in this condition.

In this "donut view" we are looking at the vessel sliced across - as if you took a drinking straw and made a couple of cuts across it at right angles to the length of the straw, and then took a look down the pipe. This vessel is normal - like we all come equipped with at birth. The white space marked "lumen" is where the blood from the heart would flow to the rest of your body.

This view on the left is showing the early stages of vascular disease with the formation of what is called a "plaque" generally made up of cholesterol and sometimes calcium.

This example shows a very serious problem. Look at the six o'clock position (tip of the arrow)
and you will see that the smooth layer or sleeve - called the endothelium - has ruptured. Up until
now, that layer has prevented any direct contact between the blood flowing by and the material within
the plaque.

Once the material underneath the sleeve is exposed to the passing blood, the blood begins to clot. In this process, a narrowing that might have been 40 or 50% of the cross sectional area of the artery can become an 80, 90, or l00% narrowing within seconds or minutes. This is the process that causes most heart attacks and sudden death.

Have you taken your "LIFESAVERS" today?

Now that you have seen the steps in the process, it is easier to understand what we can do to try to prevent it from occurring. Most importantly, we are interested in stabilizing the plaque so that it is not "vulnerable" to rupture. This is achieved through good blood pressure control, reduction of cholesterol, cessation of smoking and use of the "LIFESAVERS". Each of the lifesavers works in different ways to protect your blood vessels. For example, drugs like ASA (ASPIRIN®) and clopidogrel (PLAVIX®) help to prevent clotting of the blood if a plaque rupture occurs. Using drugs like the statins helps to stabilize the surface of the plaque so that is less likely to rupture .

Here's another way to look at the vascular disease process that shows how it progresses over our lives:

Am I at Risk for Vascular Disease?

In a word, yes. We are all at risk and virtually everyone who reaches adulthood in our society has some early manifestations of vascular disease. Whether those early changes turn in to big problems is dependent on many things, some of which are completely within your control - like smoking. Others we can't control like who your parents were and how old you are. Major risk factors include smoking, high blood pressure, diabetes, cholesterol, weight, sedentary life style and family history. About 40% of the population in modern societies will die from vascular disease. In contrast, cancer accounts for a little under 30% of deaths in most countries.

What parts/organs can be affected by vascular disease?

The organ that is most vulnerable is the heart itself. Most of the vascular deaths are due to heart attack or its aftermath like heart failure in people who have their heart muscle damaged by heart attack. The brain (stroke), the kidneys (kidney failure leading to dialysis) and the legs (peripheral vascular disease) with pain on walking or even the need for amputation are other problem areas in patients with vascular disease.

What if it is just in my legs, do I still need to worry?

Yes, you still need to worry because there is no such thing as vascular disease that is "just
in the legs". Once you have vascular disease anywhere, you have vascular disease everywhere. If
we looked at your heart vessels under the microscope it would be there too. This is a relatively
new concept but it actually helps to simplify the approach to vascular disease because now, no matter
where we first find the disease, we treat it in exactly the same way - With the LIFESAVERS and with
lifestyle changes that help to protect all of your organs from vascular disease.

How is vascular disease investigated?

There are really just two questions to be asked:

Is vascular disease present or not?

Is the vascular disease that is present causing a significant short-term threat to the person
who has it? (All vascular disease causes a significant longer term threat).

Vascular disease - present or not?

If there is a history of heart attack, stroke, blocked arteries in the legs, kidney failure due to blocked arteries, or diabetes, then vascular disease is already present and all of the treatments are utilized to prevent its worsening over time.

But, what about people who seem healthy without any of the problems listed above? Could they have early vascular disease and how do we find out?

By the time we reach adulthood, all persons in our society have some degree of vascular disease. In some cases it can be detected only under the microscope but there are ways to detect disease without taking you apart. One useful technique is to look at the arteries in the neck using ultrasound. This is a simple, safe, and highly accurate way to detect very early changes in the arteries that signal the onset of vascular disease. If such changes are found, we usually initiate therapy with the LIFESAVERS - statins, ACE or ARB drugs and aspirin or clopidogrel.

OK. So I have proven vascular disease. What now?

If there is a proven diagnosis, or even if we just find a little thickening of the arteries in
your neck then you need all of the treatments that work for vascular disease. They are the LIFESAVERS
and lifestyle changes that you can review in more detail on the information sheet. But that's
not all. You also need to be investigated for vascular disease elsewhere, particularly in the
heart. Why the heart? Because no matter where else vascular disease is found in your body, your
greatest risk of dying from this disease is heart attack or complications of heart attack. For
this reason, we look for signs of your heart arteries being involved. This is usually done by having
you undergo a stress test either exercising on a treadmill or bike, or if you can't exercise to
a high enough level there are ways to use medications to simulate exercise thereby allowing us
to find out if there are any blockages.

What if the blockages are in my heart?

What we do then depends on where the blockages are and how severe they are. Some situations are best treated with medication alone but nowadays most people are best treated with a mechanical approach to provide a new blood supply to the area affected by the blockage. Increasingly this is done without surgery just using catheters that are manipulated inside the blood vessels. Balloon based or catheter procedures are now referred to as a Percutaneous Coronary Intervention or PCI. Usually a metal stent is used to help keep the artery open. The other approach is Coronary Artery Bypass Grafting or CABG. In this case, major surgery is performed with opening of the chest and a new blood supply to all areas using different arteries or veins to get around the area of trouble.

How big a difference will taking my medications make?

Quite a lot. Although having vascular disease is a scary proposition, the treatments actually
work very well. Once you have established vascular disease, the risk of a significant vascular
event including stroke, heart attack, death and need for PCI or CABG is about 7% per year. But
if you take your medications, see what happens: Use of any one of ASA/Clopidogrel, ACE or ARB therapy,
or statin reduces the risks as shown in the slide below:

The slide shows the additive effect of each drug. Using just one gives some benefit but using all three gives the most benefit.

So, you can see that if you take all three classes of these drugs you reduce risks each year from 7% to 2%. That cuts your risk more than in half, just by taking your drugs regularly. See why we call them the LIFESAVERS?

This introduction to vascular disease is meant to help you understand the condition and its treatment. More detail will be available on this site in the future and through this via links to other authoritative resources. Please visit again.